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Concomitant TV Repair During CABG — EECC MCQ

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ModerateValvular Heart DiseaseConcomitant TV Repair During CABGEECC

A 68-year-old man with moderate-severe functional TR is undergoing CABG. The surgeon asks whether concomitant tricuspid intervention should be performed. What is the current recommendation?

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Correct answer: E — Concomitant TV repair (typically ring annuloplasty) should be considered during left-sided valve surgery or CABG when significant secondary TR or tricuspid annular dilatation (≥40 mm) is present, as isolated late TV surgery carries high operative risk

The 2025 ESC/EACTS VHD Guidelines recommend concomitant tricuspid valve intervention (Class IIa) during left-sided valve surgery or CABG when: (1) severe TR is present; (2) moderate TR with tricuspid annular dilatation ≥40 mm (or >21 mm/m²), as progressive annular dilatation predicts TR worsening over time. The rationale: secondary TR often progresses after left-sided surgery if untreated, and isolated late TV surgery carries significantly higher mortality (5-10%) than concomitant TV repair at index surgery (<1% incremental risk). Ring annuloplasty (rigid or semi-rigid undersized ring) is the preferred repair technique for secondary TR.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease